Provider Demographics
NPI:1740910751
Name:MAIDEN, JASMINE K
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:K
Last Name:MAIDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42264 SAND PALM WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-1279
Mailing Address - Country:US
Mailing Address - Phone:661-524-4003
Mailing Address - Fax:
Practice Address - Street 1:1529 E PALMDALE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2029
Practice Address - Country:US
Practice Address - Phone:661-942-4719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No171M00000XOther Service ProvidersCase Manager/Care Coordinator